Navigating health insurance selection for in vitro fertilization (IVF) benefits: A study protocol

Introduction: A large public university added health insurance coverage of 50 % co-insurance for up to two cycles of in vitro fertilization (IVF) to eligible faculty and staff. Methods: We describe the design and conduct of a randomized controlled trial to evaluate the effectiveness of a health insurance educational intervention on health insurance literacy and IVF benefit utilization. The intervention materials included 1) Key insurance terms; 2) Examples of premiums and deductibles across the insurance plan options; 3) Examples of how premiums and deductibles affect out-of-pocket costs; and 4) A guide to find in-network providers/facilities. The primary outcome is health insurance literacy. Secondary outcomes are IVF services and insurance benefit utilization, out-of-pocket costs, and financial hardship related to fertility care. We will integrate mixed methods data to explore whether the intervention was effective, feasible, acceptable, and appropriate. Results: Among 394 faculty and staff screened, 217 (55 %) reproductive-aged (18 to 50 years) employees consented, completed the baseline survey and were randomized in a 2:1 fashion. Participants were female (81 %), married (63 %), and worked as a staff employee (72 %). At baseline, approximately 39 % reported an infertility diagnosis, and 28 % had undergone prior IVF treatment. Participants reported feeling slightly confident when using their health insurance plans and moderately confident being proactive when using their health insurance. Discussion: Our goal is to improve health insurance literacy and utilization of health insurance benefits for IVF care, thereby expanding family-building options for reproductive-aged individuals. Trial registration: Clinicaltrials.gov Identifier: NCT05663645 https://clinicaltrials.gov/study/NCT05663645